Provider Demographics
NPI:1992410799
Name:HOLGUIN, GERARDO JR
Entity type:Individual
Prefix:
First Name:GERARDO
Middle Name:
Last Name:HOLGUIN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6902 EMERSON DR
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-1150
Mailing Address - Country:US
Mailing Address - Phone:714-290-3264
Mailing Address - Fax:
Practice Address - Street 1:220 S BARNWELL ST
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-4507
Practice Address - Country:US
Practice Address - Phone:619-246-0561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-17
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD2036423OtherDRIVER LICENSE